Bhaktapur Cancer Care Center

Diwakar Rajkarnikar, president of the Nepal Cancer Relief Society (left), and a resident oncologist welcome patients to the Bhaktapur Cancer Hospital. The INCTR is supporting its cervical cancer screening program.

Nepal is a small landlocked country between India and the Tibetan Autonomic Region of the Republic of China and is one of the ten poorest countries in the world—a result of centuries of feudal autocratic regimes in a country completely isolated from the rest of the world by the high Himalayan Mountains.

Since its liberation into the modern age in 1951, Nepal has been spending its health care budget on the prevention of communicable diseases. Only recently has Nepal been able to take interest in cancer prevention and treatment.

In 1992 the Nepal Cancer Relief Society (NCRS) opened the Bhaktapur Cancer Care Center (BCCC) in an old building at Bhaktapur, one of the cities in the Kathmandu Valley. It provided treatment with surgery and chemotherapy only, but lacked radiotherapy services because of the prohibitive initial costs.

In 1995, The Rotary Club of Mansfield in the United Kingdom initiated a project to establish a radiotherapy department at BCCC at the request of NCRS through the Rotary Club in Nepal. The Rotary Foundation contributed almost $400,000 to buy a CIRUS Cobalt 60 radiotherapy machine from France and the Nepalese government's Ministry of Health provided 70% of the building costs. NCRS raised the rest from the public and various institutions and societies in Bhaktapur.

The Rotary Club of Mansfield sent two volunteers to Bhaktapur in 1998 to train six Nepalese graduates as medical physicists and therapy radiographers for the initial commissioning of the radiotherapy services. In 1999, King Birendra of Nepal, accompanied by Queen Aishwarya Rajya Laxmi Devi Shah, ceremoniously inaugurated the new Center. The new BCCC was a supreme example of how NGOs like NCRS and the Rotary International, in collaboration with His Majesty's Government (HMG) of Nepal, the public, and various institutions and societies in Bhaktapur, could successfully work together to provide much-needed radiotherapy services for cancer patients. More than 100 destitute patients have since benefited from radiotherapy treatment.

Mansfield Rotary Club also established a pilot clinic for screening women for cervical cancer by pap smear; cervical cancer in Nepal is one of the biggest killers of women. The Club also established the first cancer library in Nepal at BCCC.

Since that time, the Rotary Club has provided two Ambassadorial Scholarships to BCCC for postgraduate studies at Nottingham University for one academic year each, and recently funded a new laboratory to provide haematology and histopathology services. BCCC is twinned with the Department of Oncology at Aberdeen Royal Infirmary, where the Head of the Department is David Hurman, who acts as technical advisor to BCCC.

An autonomous management committee runs the BCCC voluntarily with a partial grant from HMG. The remainder of the cost is met through patient fees; there are no free health services in Nepal. In a very short period of time, BCCC has proven to be a formidable cancer institute serving the Kathmandu Valley (population 1 million). But BCCC still lacks much essential equipment that would normally be found in a modern cancer hospital, the most important of which is a treatment simulator.

Patients are referred to BCCC from other tertiary centers in the region for opinion and treatment. Presently, BCCC operates 25 beds for chemotherapy, palliative care and pain management services. About 1,000 new cancer patients, both children and adults, are seen each year. Doctors treat cancers of the lung, cervix, breast and ovary, as well as leukemias. In addition to the hospital's well-woman clinic for cervical cancer screening and breast self-examination, BCCC takes education programs and screening camps to the outskirts of the municipal region. Nepal Cancer Relief Society is taking a lead in preventive programs as well. Thirty-two of the 75 districts in Nepal are served.

Partnering With INCTR
INCTR has proven to be a vital partner for developing cancer services in Nepal. INCTR has supported BCCC's initiatives to undertake a more comprehensive cervical cancer screening program (based on direct visualisation with acetic acid, rather than pap smears) in the Bhaktapur District, in collaboration with the IARC. The IARC has already provided a colposcope, cryotherapy and LEEP (loop electrosurgical exision procedure) equipment for the treatment of premalignant lesions, and has trained doctors, nurses and staff in screening methods and colpscopy practices. As we continue, we hope to develop additional modern methods to fight cancer. We consider INCTR our "big brother by our side," as we strive to bridge the gap between developing and developed countries in the fight against cancer.

INCTR's keen interest in improving cancer services in developing countries and its goal to send help where it is needed most will prove beneficial for our country. Its additional objective to facilitate research activities will certainly help countries like ours in the days to come.

Dr Aarati Shah, Medical Director,and Dr Bibek Padhan, Chairman, Nepal Cancer Project, The Rotary Club of Mansfield, UK, contributed to this article.

Detailed Statistics of Bhaktapur Cancer Care Center Facilities – Inpatient and Outpatient service to cancer patients. Number of Hospital Beds – Twenty-five (with plans to add eight beds in near future) Doctors – Eleven including oncologists, surgeons, anaesthetists Nurses – Thirteen Medical Physicists – Three Therapy Radiographers – Four Laboratory Technicians – Two Total Staff – Forty-five including administrative and ancillary services New Patients attending OPD – Approximately 3,200 per year New Radiotherapy Patients per year – Approximately 450 per year. Women attending Cervical Smear Clinic – Approximately 600 per year Field Work – BCCC conducts several health camps for cancer awareness and screening work.